Q&A: Iterate. Adapt. Replicate.

Unpacking the role of design in scaling global health solutions

Visuals by Nicole Kraieski & Joan Encarnacion

In pursuit of scalable solutions in the global health sector, IDEO.org has spent the past decade exploring how design can aid in crafting, adapting, and replicating interventions that thrive across multiple contexts.

In this dialogue, Michelle Kreger of IDEO.org and Georgina Page of MSI Reproductive Choices, reflect on La Famille Idéale—a solution designed to generate demand for family planning in communities across the Sahel. Anchored around a board game, this multi-faceted tool is designed to catalyze conversation, create an environment that encourages further discussion, and ultimately facilitate access to services.

Initially designed in Burkina Faso, both organizations went on to adapt and replicate the tool in Senegal, Mali, and finally, Niger. IDEO.org and MSI collaborated through quick sprints in each country to explore necessary changes and co-create an adapted version alongside each MSI country team.

Kreger and Page discuss what adaptation and replication looked like in practice and reflect on how human-centered design can achieve broad impact and scalable solutions.

This conversation has been edited for length and clarity.

MSI's Foray into Design

Georgina Page (Head of Social Behavior Change at MSI Reproductive Choices): The rising interest in Human-Centered Design (HCD) from donors and partner organizations, along with a strong focus on adolescent sexual and reproductive health and rights (ASRHR), played a key role in MSI's decision to experiment with design nearly a decade ago. This convergence motivated MSI to adopt a youth-focused approach, emphasizing participatory methods to tackle the issues facing young men and women. A pivotal factor in our journey was our collaboration with the Hewlett Foundation. Their genuine interest in supporting innovation through flexible funding allowed us to be steeped in a process that promised transformation but not necessarily clear outcomes and deliverables.

And let’s be honest, we didn’t nail it right from the start. Our initial forays into HCD, like the Diva Centres project, were full of learnings We ran into challenges with implementation and scale, but ultimately, we've been able to build on all of that. That’s design—there’s always something to take forward, to iterate on…the learning, the ideas, the materials, the assets.

Michelle Kreger (Managing Director, Partnerships at IDEO.org): Totally. There were so many mutual learnings. If we were to embark on the Diva’s Project now, we would do things so differently. In the long run, both projects probably achieved more than we initially aimed for, despite feeling a bit rough along the way.

Georgina Page: Definitely.

Adaptation & Replication: Scaling La Famille Idéale

Michelle Kreger: I wonder if a specific moment comes to mind where the value of HCD in replication and scale was particularly clear for you and your team.

Georgina Page: When we started the La Famille Idéale project with IDEO.org in 2017, we set out to build an adaptable solution to engage young couples in family planning discussions. After La Famille Idéale’s success in Burkina Faso, we were ready to explore an adaptation in Senegal. When we introduced it to our team there, we faced some resistance. Understandably, they felt the game wasn’t well tailored for the communities they were trying to reach—it didn’t click, and ultimately, they didn’t think it would work for them.

The “we build, you use” mentality was pretty prevalent at the time, but having just gone through several months of HCD, we applied our learnings internally and worked with the team to iterate in the field. We assured our team in Senegal that if La Famille Idéale flopped after testing and iteration, we would develop a different tool.

MSI utilized HCD to adapt and refine La Famille Idéale with their Senegal team. The success of the process facilitated the tool's expansion into Niger and Mali.

In Senegal, La Famille Idéale underwent adaptations, including several visual and mechanic modifications to the board game. These changes aimed to better resonate with local communities by reflecting their unique family structures, social norms, and environments, ultimately making the tool more relevant and engaging for participants.

This shift in strategy transformed everything—it was a real aha! moment for us. Coming from a research background, involving the people you're designing for was second nature to me. The importance of involving the implementing teams, however, was revelatory. We put our Senegalese team at the heart of our process alongside the users. We leveraged their expertise and invited them to redesign La Famille Idéale according to their learnings and knowledge. It may seem obvious, but it was a critical approach for achieving internal buy-in and building a more effective tool.

Michelle Kreger: Absolutely, engaging MSI’s team in Senegal was pivotal to the adaptation process. We overhauled the visual elements of the game, introducing illustrations that more accurately represented local family structures and buildings. We revised role cards so the scenarios would resonate with the communities we introduced the tool. All said and done, this adaptation was much less costly than building an entirely new tool altogether.

Georgina Page: It also gives you a variety of champions when it’s time to scale the tool. When you have people in a variety of roles organically persuading their peers, that's a real game changer. In my experience, HCD isn’t just about implementing a new tool or process; it's about creating a system where a range of stakeholders, regardless of their role, feel invested and see the direct benefits of the change. That's how you achieve real, sustainable success.

Between Innovation and Calculable Impact

Michelle Kreger: Let’s talk about the obstacles in implementing HCD as a tool for scaling solutions at MSI.

Georgina Page: The investment in time and resources is tough. Even with a ‘light-touch’ approach, practicing HCD still means dedicating time to testing, iterating, and diving deep into a process that doesn’t always have clear outcomes.

At a service-delivery-focused organization like MSI, speed and efficiency are key. We tend to engage in a fairly narrow set of activities, and we excel at them. We want to maximize the impact we can have on people’s lives, and we can very precisely show what each dollar achieves. Saving lives by preventing maternal deaths and unsafe abortions—that’s tangible, clear, and quantifiable.

This model and mindset around impact can create tension when we want to innovate because it requires risk. We're often torn between sticking with proven methods and experimenting with new approaches that don't always have guaranteed results. It's a delicate balance of managing expectations, accepting the possibility of failure, and being transparent about the outcomes.

But honestly, this tension is healthy. When you’re pooling a significant amount of resources—people, funding, time—into a process that can be perceived as inefficient or lacking guaranteed impact, it should be scrutinized. Especially because it means you’re taking those resources and that time away from something else with measurable results.

Leveraging design at an organization like MSI will—and probably always should—be a bit of a battle.

I think the trick is to engage people in this iterative process without them fully realizing it. If the changes and iterations are driven by the project's needs or by new learnings that emerge along the way, it starts to feel more organic, more like a natural part of the workflow rather than an added burden. It’s all about making the process of iteration feel like a seamless, integral part of the journey rather than an endless cycle of revisions.

On Design's Evolving Value

Michelle Kreger: I’m curious how you see the role of a group like IDEO.org’s evolving; We learned so much together from co-creating La Famille Ideale in Burkina, and then replicating and adapting it together in Senegal, Mali and Niger. Knowing what you know of us, how would you see our role evolving to solve hard problems in the future?

Georgina Page: My thoughts on this go in two opposite directions. There’s the role of being an ad-hoc sounding board offering rapid input into innovations and testing. This gap-filling resource could be particularly valuable for an organization like MSI where maintaining broad in-house design capabilities isn’t feasible. Having a partner who knows us well and is flexible enough to jump in as needed would be immensely helpful for me and my team.

On a broader scale, it would be fantastic to see the principles of design applied more at the system level. As our work in health system strengthening evolves, it has grown more intersectional—addressing health and climate change, for example. HCD stands out as a powerful tool for managing the complexities of collaborating across sectors and disciplines. It could facilitate uniting stakeholders from different domains, encouraging us to put aside individual agendas to focus on jointly identifying and tackling challenges efficiently.

It's like extending the concept we discussed earlier about engaging your whole organization to get everyone on board—but on a meta-level.